The document discusses bone tumors. It begins by stating that the most common bone tumor is secondary tumors from other sites, while the most common primary bone tumor is multiple myeloma. It then covers the WHO classification of bone tumors including bone-forming, cartilage-forming, marrow, vascular, and other tumors. Diagnosis involves clinical examination, imaging like radiographs, CT, MRI and bone scans, as well as laboratory tests and biopsy. Staging is discussed including the Enneking system based on aggressiveness and spread. Management depends on staging and includes wide excision for low grade lesions and more radical resection or palliative treatment for high grade or metastatic tumors.

1. Bone tumours Dr.Surya prakash sharma MBBS D’ortho (PG Student) MMC Chennai

2. Bone tumours Commonest bone tumour is secondaries from other sites Commonest primary bone tumour is multiple myeloma, second osteosarcoma.

3. Classification (W.H.O.) Bone-forming tumours Cartilage forming tumours Giant-cell tumour Marrow tumours Vascular tumours Other connective tissue tumours Other tumours Secondary malignant tumours of bone

4. Bone forming tumours

5. Cartilage forming tumours

6. Giant cell tumour Osteoclastoma

7. Marrow tumours Ewing’s sarcoma Neuroectodermal tumour Malignant lymphoma of bone (Primary/secondary) Myeloma

8. Vascular tumours Benign Haemangioma Lymphangioma Glomus tumour Intermediate Haemangio endothelioma Haemangio pericytoma Malignant Angiosarcoma Malignant haemangio pericytoma

9. Other connective tissue tumours Benign Benign fibrous histiocytoma Lipoma Intermediate Desmoplastic fibroma Malignant Fibrosarcoma Malignant fibrous histiocytoma Liposarcoma Malignant mesenchymoma Leiomyosarcoma Undifferentiated sarcoma

10. Other tumours Benign Neurilemmoma Neurofibroma Malignant Chordoma Adamantinoma

11. Secondary malignant tumours of bone From primary in: Thyroid Breast Bronchus Kidney Prostate

12. Diagnosis Clinical examination Imaging Laboratory investigations Biopsy

13. Imaging Radiographs CT scan MRI Radio nuclide bone scan Arteriogram

14. Radiographs Exact location of the tumour Borders of the tumour Pattern of bone destruction Matrix formation Periosteal reaction

15. CT Scan Very useful in early diagnosis Extra osseous extension Early detection of pulmonary secondaries Exact measurement for limb salvage procecures (Prosthesis/allograft)

18. MRI Intra medullary extension Soft tissue extension Defines the relationship to the nearby major blood vessels

20. Radio nuclide bone scanning For pre biopsy staging Dissemination of tumour Silent secondaries and skip lesions

21. Arteriogram Planning limb sparing surgery Therapeutic embolization To assess vascularity of tumour

22. Laboratory investigations Hb % ESR Alkaline Phosphatase Serum electrophoretic pattern Bence-Jones protein Acid Phosphatase

23. Biopsy Closed biopsy FNAC Needle biopsy Open biopsy Incisional biopsy Excisional biopsy

24. Principles of biopsy From boundary or edge of tumor Take several samples Incision strategically placed Ideally done by the treating surgeon Wound closed without drain

25. Staging of the tumor By Enneking (1986) Based on aggressiveness of the tumor and Spread

26. Staging (Enneking) Intra compartmental Extra compartmental Low grade I-A I-B High grade II-A II-B Low/High grade with metastasis III-A III-B

27. Correlation of staging and management I-A - Wide excision I-B - Wide excision with larger clearance II-A - Wide excision/amputation II-B - Radical resection or disarticulation III - Palliative treatment Low grade intra compartmental lesions – wide resection and management of metastases

28. Principles of management Benign, asymptomatic lesions Excisional biopsy or curettage Benign, symptomatic or enlarging lesions Biopsy confirmation followed by marginal resection or curettage (cystic lesions)

29. Principles of management Suspected malignant lesions Laboratory and imaging investigations Chest x-ray or CT scan of the chest Biopsy confirmation Surgical options Ablative surgeries (amputation/disarticulation) Limb sparing surgeries Chemotherapy Adjuvant/Neo-adjuvant Radiotherapy

30. Thank You